The influence of low calcium dialysate on left ventricular diastolic function in peritoneal dialysis patients

Left ventricular (LV) diastolic function was found to be a significant predictor of cardiovascular events and general mortality in dialysis. Studies have indicated that dialysate calcium concentrations were significantly associated with cardiac function. However, the relationship between low calcium dialysate and LV diastolic function has not been clear. The aim of this study was to investigate the influence of low calcium dialysate on cardiac function in peritoneal dialysis (PD) patients. A total of 60 PD patients were enrolled in this study, with a calcium content of the PD solution of 1.25?mmol/L in 30 patients (low-calcium group) and 1.75?mmol/L in 30 patients (standard-calcium group). Standard M-mode and two-dimensional ultrasound measurements were applied to detect the cardiac function. After 12-month follow-up, we found no significant difference in blood pressure, calcium, phosphorus, parathyroid hormone (PTH), etc., between the two groups. Residual renal function (RRF), which is associated with LV cardiac function, was significantly decreased in the standard-calcium group compared with the low-calcium group (5.64?±?3.23 vs. 9.38?±?3.17, p?=?.001). Compared with the low-calcium group, E_max (peak early diastolic velocity) and A_max (peak late diastolic velocity) were significantly decreased (p?p?相似文献   

三种用于血液透析和相关治疗用水微生物学监测方法的评价

目的评价三种方法用于监测血液透析和相关治疗用水微生物检测的效果。方法在某次飞行检查中采集36所受检单位的血液透析液和透析用水72份,分别采用血琼脂平皿(35℃,72 h)、胰蛋白酶大豆琼脂(TSA)平皿(35℃,72 h)、R2A营养琼脂(23℃,168 h)三种方法进行培养,比较三种方法菌落计数、菌落和超干预值(≥50 CFU/mL)检出率的差异。结果采用三种方法对透析液和透析用水进行检测,血琼脂平皿、TSA平皿、R2A营养琼脂菌落检出率分别为40.28%、63.89%和69.44%,差异有统计学意义(χ~2=14.16,P0.05);两两比较结果显示,R2A营养琼脂和TSA平皿检出率高于血琼脂平皿。血琼脂平皿与R2A营养琼脂、TSA与R2A营养琼脂检出菌落计数比较,差异有统计学意义(Z值分别为-4.515、-6.970,均P0.05)。血琼脂平皿、TSA平皿、R2A营养琼脂法检测透析液和透析用水菌落数,超干预值检出率分别为1.39%、4.17%和20.83%,差异有统计学意义(χ~2=19.83,P0.05),R2A营养琼脂检出率高于其他两种方法。结论 R2A营养琼脂和TSA平皿检出率优于血琼脂平皿,R2A营养琼脂超干预值检出率高于TSA平皿和血琼脂平皿,R2A营养琼脂(23℃,168 h)用于血液透析和相关治疗用水微生物监测优于其他两种方法。     

Antibiotic activity in peritoneal dialysate

There are few studies investigating whether antibiotics added to 30% glucose concentrate preserve their activity in the delivered dialysate. Using a Drake-Willock proportioning system, samples were obtained from the "to" patient path at ten minutes after starting and at four hours. Samples were tested for minimal inhibitory dilution (MID) against Escherichia coli and Staphylococcus aureus. Antibiotics evaluated included amikacin, tobramycin, gentamicin, cephalothin, cefamandole, moxalactam, ampicillin, penicillin, carbenicillin, and vancomycin. In all antibiotics studied, similar MIDs were obtained at the ten-minute and four-hour samples. Compared to saline, dialysate significantly impaired the antibiotic activity (a difference of two or more tube dilutions) of all antimicrobial agents except amikacin and vancomycin.     

Low-sodium haemodialysis without fluid removal improves blood pressure control in chronic haemodialysis patients

SUMMARY: Hypertension is an important and well‐established risk factor for both cardiovascular and cerebrovascular disease. Hypertension is much more common in patients on renal replacement therapy than in the general population. Up to 80% of patients on renal replacement therapy are hypertensive and about 50% of dialysis patients die from cardiovascular causes. Salt and water overload are major factors exacerbating hypertension in the dialysis population. This was a prospective crossover study of 10 patients examining the effect of haemodialysis for 2 weeks using usual (Na⁺ 138–140 mmol/L) sodium dialysate with a 2‐week period of low (reduced by an average of 5 mmol/L Na⁺ to 133 mmol/L on average) sodium dialysate on inter‐dialytic ambulatory blood pressure (ABPM) and trans‐thoracic bioimpedance (TTB). Ten patients, mean age 67 years, completed the study (two women and eight men). No patient became severely hyponatraemic during the study period. Mean 48 h inter‐dialytic blood pressure (BP) fell from 141/83 to 133/78 (P < 0.01). Mean arterial BP measured immediately prior to TTB fell from 92.8 mmHg to 87.5 mmHg (P < 0.01) during the low‐sodium haemodialysis period. Afterload (systemic vascular resistive index – SVRI) measured by TTB fell significantly during the low‐sodium haemodialysis period (SVRI on Na⁺‐140 = 3426 cf. Na⁺‐134 = 2281; P = 0.01). Dialysate sodium reduction without extra fluid removal had a beneficial effect on inter‐dialytic 48‐h blood pressure in chronic stable haemodialysis patients. Lowering dialysate sodium reduced the systemic vascular resistance index as measured by TTB. Reduction of dialysate sodium was well tolerated, although mild dizzines and cramps did occur. These data suggest that sodium overload and water overload may have independent effects on BP and that simple‐to‐achieve and modest changes in dialysate sodium could usefully augment the action of antihypertensives in dialysis patients.     

PCR检测腹膜透出液中的金黄色葡萄球菌

检测腹膜透出液中的金黄色葡萄球菌。方法应用ＰＣＲ检测未感染的及已感染的腹膜透出液,并与传统培养方法进行对比。结果培养出金黄色葡萄球菌的腹透液,ＰＣＲ均出现了２７９ｂｐ的特异性扩增带,且ＰＣＲ检出率高于培养法。结论ＰＣＲ与培养方法相比具有快速、特异,敏感的优点,而且不受抗菌素使用的限制。     

腹膜透析液添加尿激酶对腹透患者氧化应激及内皮功能的影响

目的探讨腹膜透析液添加尿激酶对腹透患者血清超氧化物歧化酶（SOD）、丙二醛（MDA）及血浆内皮素（endothelin,ET）、一氧化氮（nitricoxide,NO）的影响。方法将60例慢性肾脏病（CKD4期）患者随机分为治疗组（30例）和对照组（30例）,两组基础治疗相同,治疗组在腹膜透析液中添加尿激酶,治疗4周后观察两组患者SOD、MDA、ET、NO及临床症状的变化。用比色法测定健康对照组、对照组、治疗组血清MDA和SOD水平,用放射免疫法测定测定ET的变化,NO采用硝酸还原法测定。结果与健康对照组比较,对照组、治疗组血清SOD活性降低（P〈0．05）,NO升高（P〈0．05）,MDA含量升高（P〈0．05）,ET水平升高（P〈0．01）。对照组虽能够降低ET水平和NO,但未见SOD、MDA的变化,治疗组能够回升SOD活性,降低MDA含量,与健康对照组及对照组有明显差别（P〈0．05）,与对照组比较,治疗组在降低ET和NO方面疗效更为显著（P〈0．01）。结论腹膜透析液添加尿激酶可通过降低氧化应激反应,改善血管内皮功能,降低ET和NO水平,对CKD患者有治疗作用。     

低钙透析联合骨化三醇冲击治疗在维持性血液透析患者继发性甲旁亢中的应用

目的观察骨化三醇冲击联合低钙透析治疗不同程度血液透析患者继发性甲旁亢(SHPT)的疗效。方法选择我院42例维持性血液透析患者,按甲状旁腺素(iPTH)水平不同分为三组:A组300pg/ml0.05),骨痛、乏力、皮肤瘙痒等症状亦获得全部或部分缓解,C组患者对骨化三醇冲击治疗效果不明显。结论骨化三醇冲击治疗对中度SHPT疗效较显著,起效较快。     

含糖透析液对合并糖尿病的维持性血液透析患者血糖、血压和心率变异性的影响

目前研究提示含糖透析液可有效稳定血糖水平,显著减少透析低血糖事件发生,同时有助于稳定血压和改善心率变异性,对心脑血管风险较高的糖尿病患者尤为重要。这些发现揭示了含糖透析液在提升糖尿病患者透析治疗质量中的潜在价值。然而,针对其长期应用的安全性和有效性,仍需进一步的研究探讨。本文就含糖透析液对合并糖尿病的维持性血液透析患者在透析期间对血糖、血压及心率变异性的影响进行综述,旨在探究含糖透析液在糖尿病维持血液透析治疗中的临床应用价值,为临床决策提供科学依据及研究方向     

低钙透析液对血甲状旁腺素及钙磷代谢的影响

目的:研究应用钙离子 1 .25mmol/L透析液进行透析 3个月对患者iPTH及钙磷水平的影响。　方法:维持性血液透析患者 6例,试验前用钙离子 1. 5mmol/L透析液每周透析 3次,每次透析 4h,均使用F6透析器(聚砜膜,面积 1 3m2 )。使用钙离子 1 25mmol/L透析液透析 3.个月,此期患者饮食中钙磷的摄入量稳定,用药不变。使用钙离子 1 25mmol/L透析液之前检测透析前血iPTH,透析前后血钙和血磷浓度。3个月后复查透析前血iPTH,透析前后血钙和血磷浓度,并检测使用钙离子 1. 25mmol/L透析液单次透析前、透析后及下一次透析前的血iPTH和血钙、血磷浓度。　结果:单次透析使用钙离子浓度 1 25mmol/L的透析液透析 4h,透后血钙浓度下降,透后血iPTH[ (219 .2±143. 3)ng/L]较透前[ (157. 5±107 .1)ng/L]明显升高 (P<0. 05),至下次透析前血钙浓度及血iPTH(157. 7±125 .3ng/L)基本恢复至上次透析前水平。使用钙离子 1 25mmol/L透析液透析 3个月后,iPTH水平较未使用时明显上升[ (157. 5±107 .1)ng/Lvs(82. 5±43 .7)ng/L,P<0 .05]。　结论:单次应用钙离子 1 .25mmol/L透析液进行透析, 透后血iPTH升高,但是至下一次透前血iPTH基本恢复至上次透前水平。长期应用 ( 3个月)钙离子 1 25mmol/L透析液进行透析,钙负荷减轻,血iPTH水平升